Public Safety, 9/11, and Critical Incident Stress

Date: 2011-09-11

As I dressed for work this morning I overheard a TV news reporter’s remarks following November’s crash of the American Airlines flight out of New York, “New Yorkers are becoming far too good at responding to traumatic events. Within minutes emergency personnel were on scene providing the necessary response, and as terribly tragic as this loss of life was, most New Yorkers breathed a sigh of relief that it wasn’t another terrorist act and went on with their day. What has happened to us that something so tragic can be so quickly disregarded…”

I stopped putting on my uniform and went out into the living room to see who was talking, feeling sad and angry all at the same time. The impulse to argue with the reporter reared it’s ugly head and I fought the urge to tell someone who couldn’t possibly hear me that he was wrong. “What are you talking about?” I thought, “Of course we all still care! How could you say that?” The only problem was he wasn’t really all that far from the truth. It’s not that I didn’t care about the lives that were lost that day, but if I was really honest with myself then I knew that like the reporter I too, was more relieved then I was horrified about an event that on any other day before “9/11” would have caught my attention. But on this day all I really wanted to know was, “Is this the other shoe dropping?” and if it wasn’t then I wanted to move on because some small part of me simply couldn’t take any more.

I don’t think that I’m alone here.

No one can dispute that on September 11, 2001, when those four planes crashed, everything we once knew about our country and ourselves was irrevocably changed and no matter what we do there is no way to put the Genie back in the bottle again. “9/11” is a day we will never forget.

What we once knew as a traumatic event seems to pale in comparison to what thousands learned that day on the streets of New York, on the steps of the Pentagon, in a field in Pennsylvania, and even on the screen of the TV we remained glued to for days, even weeks, after the terrible tragedy that we now refer to as “9/11.” Those of us in the trenches, used to responding to critical incidents as part of our job, may feel at a loss for words at this point. All the training in the world could not have prepared us for what we saw and experienced that day, and although that in itself is not enough to stop us from performing our jobs, the grim reality is years may pass before we learn the true impact of “9/11.”

Oh, we know how many lives were lost but the exact toll it will ultimately take goes far beyond numbers and way beyond anything we have had to understand and accept as Americans and as emergency responders. Nothing in my life compares and I wonder if anything that I’ve done before can even begin to apply to an event of such great magnitude. A voice in the back of my head says, “Who are you kidding? You’re trying to put a Band-Aid on a wound that no one can heal from. Anyone who was there that day or is still there now, at ground zero, will never be the same again and anything you do or say will only minimize the hurt and the pain they feel. Don’t make things worse by insulting them, by implying that ‘Everything’s going to be all right,’ or that any single one of us knows the answer to what will make this right again.”

But I feel helpless, and I want to do something and like everyone else I am waiting to see what will happen next. I want our lives to go on and for America to begin healing, but I don’t know how long it will take. I don’t know if everything will ever be all right again and I’m afraid to say whether that’s a good thing or a bad thing because this is one time when no one really knows the true outcome of an experience. The mental health professional in me wants to say that even the most horrific experiences can be opportunities for transformation and change, but the human in me resists this notion like an old cliché. What I do know is that we have to keep living and the only way we can do this is to go on, putting one foot in front of the other. We don’t know how long this will take, or what it will take, but we have to try.

Tragedy is not unfamiliar to those of us in the field of emergency public safety. As fire fighters, police officers, rescue workers, emergency dispatchers, and in other professions of a similar ilk we are routinely involved in providing help to victims, and because we are professional caregivers we rarely see ourselves as “victims” or as people in need of “help.” Our job is helping others, and not asking others to help us. As a consequence, sometimes we put ourselves last on the list of people to take care of because we know another days work is coming.

I used to think this was about being afraid that others would see us as weak or incapable, (although that is sometimes true) but now I believe that for many individuals asking for help for ourselves simply doesn’t occur to us. If everyday we are exposed to tremendous stress, either acutely through a critical incident, or cumulatively, throughout our professional lives then how is one day’s critical incident really any different then all the others? The difference becomes negligible and we become content with simply enduring when it hurts and hoping for the best when it’s over.

Few people, regardless of their technical expertise, were prepared for a terrorist attack of this magnitude on American soil and certainly no one was prepared to engage in such dramatic rescue efforts with so few surviving victims. In the days and weeks, and now months, that have followed, the emotional drain that accompanied this event has been enormous, and it is still not over.

With most critical incidents there is a trauma that is for all intents and purposes easily identifiable, exact, and circumscribed. Unless you are the victim, the perpetrator, or the first responder, or a news crew covering the event, the effects are limited to those who are directly involved in the event. Therefore debriefing and recovery is specific to that group and readily quantifiable. But our loss is a collective one that transcends most normal boundaries, and has not only changed the face our emergency public safety community but it has changed the collective consciousness of our world, as we know it. Healing from our collective loss will take time, and what may have worked before may be less effective now. Additionally, the weight of this loss and trauma is not limited to those who responded physically on scene. It extends out to us all, and its impact should not be minimized by the collective anxiety we may all feel about the uncertain future.

We’ve been inundated with information, traumatized on more levels then we thought possible, lost more people then we could ever have imagined and yet, like the dispatchers taking the next call we’re still plugging in. It takes courage to come back for more and it will take even greater courage and fortitude to heal from this.

The following represents a short and not all-inclusive list for how to support someone who’s been through a critical incident, such as “9/11.”

How to Support Someone Who’s Been Through A Critical Incident Such As “9/11”

Your attitude is key to effectively supporting someone who has been through such an event. Whatever the incident, whether “9/11,” another plane crash, an Anthrax scare, or something else, do not treat them as a hero or a fragile victim. Accept some adjustment reactions as natural and accept that it will take some time to “get back to normal.” In the case of an event such as “9/11,” normal may take a very long time to heal. There is no timetable and there are no certain circumstances to create it. Positive peer and family support will greatly facilitate effective coping.

Learn about critical incident trauma. The more you know the more informed your decisions will be and the less likely you will respond to someone else’s feelings reactively. Know also that people respond to critical incidents differently.

Be available! Take responsibility for initiating contact with your colleagues and friends, but avoid intruding.

Accept the response you get from the person. Do not judge or criticize his or her feelings. Be interested in the person and not just the “war stories” they might have. Be empathetic and supportive.

Events of a similar kind might re-stimulate or re-traumatize the person. Expect the potential for feelings that may emerge over time, particularly when the incident, such as “9/11” or the circumstances are not yet fully resolved or over. Be patient. Be hopeful. It’s not about you.

Listen to what is being said. Dispatchers are fond of talking and feeling some sense of control and mastery over their circumstances. They are equally adept at concealing their feelings in service to superficial dialogue that gives the appearance of conversation. Take the time to listen and let them know you hear what is being said. Avoid biased questioning, interviewing, or talking to the person only from your own vested point of view.

Be a resource. Listening and validating emotional reactions can be very helpful. Don’t be afraid to share your experiences as a dispatcher. You may not have been a first responder to “9/11” but you still have valuable insight and experiences to offer, and can help legitimize another person’s reactions. Avoid inundating them with your own “stuff.” Too much of a good thing is exactly that, too much. This isn’t about you.

Don’t give advice. Avoid relating in a condescending way by telling them how to handle things.

Be sensitive to changes in behavior and moods that indicate a person isn’t coping well. Gently challenge the real helpfulness and effectiveness of maladaptive behavior.

You are not responsible for what happened, nor are you responsible for how the person handled the critical incident. In an incident such as “9/11” many lives were lost. It is doubtful that any one dispatcher, regardless of what he or she did or didn’t do greatly affected the outcome of the terribly tragic event. You are there for support, encouragement and validating emotions, not treatment.

Know your limits! Steer the person to appropriate help when you notice a lack of resolution, maladaptive behavior, declining emotional condition, and other reactions that indicate the need for professional help. There is no shame in needing additional assistance. As a friend or colleague, you are giving your friend a gift by saying “no” when you are beyond your own personal expertise.

Often, the most beneficial support comes from those who have traveled a similar path. Again you don’t need to have experienced a “9/11” to be of some value. If you have lived through pain and suffering, and growth, from a similar event, share it. Such self-disclosure normalizes feelings and is invaluable.

Caution: Many people have experienced secondary traumatization in response to “9/11,” meaning that the events themselves were so extraordinary that they themselves have experienced stress significant enough to be classified as trauma. This is particularly relevant to dispatchers and emergency responders who are routinely exposed to varying levels of trauma on a daily basis. If helping someone through this critical incident brings up painful feelings and memories for you, ones that you have not yet dealt with, stop. If your own attitude after your experience was to block it out and press on you may have buried an emotional live wire. Also realize that someone you are helping may also have unresolved emotions from past incidents unrelated to “9/11” or November’s plane crash. Again, stop, and strongly encourage that person to seek other sources of assistance, including professional help.

We all need each other, more then ever before. Despite and because of what has happened, know this: We will prevail.

Regina G. Chace, Ph.D., clinician, researcher, and writer consults with numerous emergency public safety organizations and lectures on a variety of topics, and is currently serving on active duty with the USAF. With two new books coming out, Dr Chace remains firmly committed to the emergency public safety community, and as always has a special fondness for dispatchers.